1 / 15

Intrahepatic Shunts

Intrahepatic Shunts. James Montgomery, DVM March 30, 2009 Acc # 111557 & 111556. Acc#: 111557. Madeline 3 month old female basset hound Cystoliths Elevated liver enzymes Elevated bile acids Referred for evaluation of shunt. Acc#: 111557. Acc#: 111556. Acc#: 111557. Portal Vein.

risa
Download Presentation

Intrahepatic Shunts

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Intrahepatic Shunts James Montgomery, DVM March 30, 2009 Acc # 111557 & 111556

  2. Acc#: 111557 • Madeline • 3 month old female basset hound • Cystoliths • Elevated liver enzymes • Elevated bile acids • Referred for evaluation of shunt

  3. Acc#: 111557

  4. Acc#: 111556

  5. Acc#: 111557

  6. Portal Vein • Formed within the mesentery dorsal to the right limb of the pancreas • Confluence of cranial and caudal mesenteric portal branches • Receives blood from the GI tract and spleen • Mesenteric veins, gastroduodenal, splenic, and gastric veins • As approaches liver, sweeps from right to left and divides into right and left branches • Main right branch – right lateral and caudate process of caudate lobe • Main left branch – all other lobes

  7. Intrahepatic Shunts • Almost all intrahepatic shunts occur in large dogs • Connect portal vein branches after their divergence from the portal vein to the hepatic veins or abdominal vena cava, bypassing the hepatic sinusoids • Many intrahepatic shunts result from failure of the ductus venosus to close in infancy • 65% are anatomically considered PDV • Divided into right, left, and central divisional shunts

  8. Fetal Circulation Dyce, Sack & Wensing, Textbook of Veterinary Anatomy, 2nd ed, p. 249.

  9. Intrahepatic Shunts • Right divisional shunts • Pass through either the caudate process of the caudate lobe or the right lateral lobe of the liver before entering the vena cava • Central divisional shunts • Pass through either the right medial or quadrate lobes before entering the vena cava • Left divisional shunts • Pass through either the papillary process of the caudate lobe, the left lateral lobe or the medial lobe before entering the vena cava

  10. Madeline 1 2 3

  11. Madeline R Miller’s Anatomy of the Dog, 3rd ed, p. 453. Acc#: 111557

  12. Treatment • Often requires more than one surgery • Surgical techniques described • Posthepatic left hepatic vein attenuation – no clinical effect • Posthepatic direct shunt ligation • Intrahepatic direct shunt dissection and ligation with ultrasound guidance • Intravascular placement of embolisation coils • Intraluminal closure of the shunt via the thoracic vena cava • Transportal closure of the shunt via portal venotomy • Direct attenuation of the PDV before it enters the venous ampulla is technically less demanding

  13. Treatment • The significant blood flow through large intrahepatic shuts cannot be suddenly obstructed • Life threatening portal hypertension would develop • Causes of intraoperative death • Intraoperative shock (hemorrhagic and septic), cardiac arrest, and portal hyper- and hypotension • Postoperative survival rates: 75-89% • Peritonitis, portal vein thrombosis, and portal hypertension are most common postoperative causes of death

  14. Prognosis • Predictors for postoperative complications • Low body weight (<10 kg) and hypoproteinemia or hypoalbuminemia • Shunt location had no effect on short or long-term outcome • Partially attenuated shunt survival rates • 1 year – 60% • 2 year – 55% • After 4 months, euthanasia due to failure to show clinical improvement was most common cause of death

  15. References • Mathews KG, Bunch SK. Vascular Liver Diseases. In Ettinger SJ, Feldman EC, eds. Textbook of Veterinary Internal Medicine, 6th ed (St. Louis, MO: Elsevier, 2005) pp. 1453-64. • White RN, Burton CA. Anatomy of the patent ductus venosus in the dog. Veterinary Record (2000) 146, 425-9. • Whiting PG, Peterson SL. Portosystemic shunts. In Slatter D, ed. Textbook of Small Animal Surgery, 2nd ed (Philadelphia, PA: WB Saunders Co., 1993) pp. 660-74.

More Related